Fraud: Identification and Prevention

Casey Wheeler

Fraud Specialist

Fraud is not a victimless crime. Fraud violates all of the taxpayers who support state and federal long-term care programs. We all have the responsibility to look for fraud and protect the integrity of the programs and people we serve.

What is fraud?

Fraud is the wrongful or deceptive intention to make financial or personal gain. With the pressures in today’s society, some people feel that the only way they can make ends meet is to commit an act of fraud. They rationalize their intentions by thinking that they deserve this money and that their actions do not hurt anybody. Once they see an opportunity to commit fraud, they take it. Unfortunately, a single act of fraud often leads to additional violations.  Fraud’s short-term benefits bring serious long-term consequences, including felony charges, large fines and restitution.

What is the most common form of fraud we see?

The most common fraud we currently see is billing for hours that are not worked. How does this work?

• The program participant makes a deal with one of their employees.
• The employee records more hours than they actually worked (if worked at all).
• The employee gives the participant the money resulting from the extra hours being billed.

Sometimes participants think their allocation is their money. It is not. The allocation reflects the amount of services that the participant is able to receive within that given total.

What can we do to prevent fraud?

There are many ways we can help program participants understand fraud.  Within IRIS, the state of Wisconsin’s self-directed care program, care consultants meet with their assigned participants and complete a participant education form. Once the participant has gone over the material and understands it, they sign the form so all parties can be on the same page.

As a financial management services provider, we educate participants about fraud.  Resources like this info-graphic give participants the information and knowledge to successfully self-direct their services.

Looking out for fraud and reporting suspected activity protects people receiving care, supports those providing care, and strengthens the integrity of long-term care programs.

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Resolutions for 2015

Amanda Cavanagh
Director, Research and Business Development

January is a time for New Year’s resolutions.  When I set goals for the coming year, I envision myself on December 31, 2015.  What do I want to look back on and be proud that I accomplished?

I recently met an amazing participant who receives support and services through one of the long-term programs iLIFE serves.  In the past, this individual’s caregivers took advantage of them.  Not only did they have to fit into the caregiver’s schedule, but they also had to deal with workers unwilling to perform specific tasks they needed done. This abuse of power by a caregiver is tragic.

We then talked about resolutions for 2015.  Although this person is striving to overcome poor caregivers in their past, they are determined to reach their goals.

“This year I will be able to live independently in my home.”

“Next year, I hope to be able to leave my home without assistance.”

This individual’s hopes and dreams exceed all limitations they currently face.  Their strength is an inspiration and reminds me that compassion is an essential part of long-term care programs.

Looking back at my first year working for iLIFE, the determination our consumers have to become independent makes me realize the limitless potential for my personal goals.

So, what is my goal for year two?  This year, I will be a champion for the people we serve.  I will start each day by asking myself, “what will I do today to make tomorrow better?”

That is a New Year’s resolution we can all commit to.

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Fraud is illegal!

Matt Queen
Communications Manager

Did you know that one-third of all elder abuse cases involve financial fraud from family members, friends, and caregivers?

Did you also know that most fraud cases go unreported?

Anybody can be a victim of caregiver fraud.  It happens across age, gender, and socioeconomic lines.  Still, fraud is often under-reported.  Why?

• Victims have close ties to the offender(s) and are protective.
• Victims think they are partially to blame.
• Victims can feel ashamed.

Throughout January, iLIFE is highlighting fraud identification and prevention. 

Educating consumers about fraud encourages participants to speak up when taken advantage of.  Knowing the criminal penalties for fraud can also discourage caregivers from abusing their employers.

As a financial management services provider, preventing fraud and protecting consumers is our priority.  Talk about fraud with the people you serve.  Starting the conversation will protect participants, strengthen your services, and maintain the integrity of long-term care programs.

Check out the iLIFE LinkedIn page for an info-graphic we share with consumers to introduce and define fraud.